In a sign that Americans are recognizing the realities they face about their changes for a comfortable retirement, The 2011 Retirement Confidence Survey (RCS) finds workers are more pessimistic than at any time in the two decades the RCS has been conducted. A few of the results:

"Not Confident" Up: More than a quarter of American workers say they are "not at all confident" about having enough money for retirement. This is an all-time high for this category.

"Very Confident" Down: Only 13% are saying they are "very confident" of a comfortable retirement. This ties for an all time low for this category.

Drawing on Savings: A third of Americans say they had to tap an IRA, 401(k), savings or investment accounts, or had to take a loan against those accounts.

42% Guessing: Well over a third say they determined their retirement savings needs by guessing.

Delayed Retirement: A significant number of workers (20%) say they now intend to retire later than they had planned.

The Universal Availability requirement states that once a plan sponsor gives any employee the opportunity to make an elective salary deferral, all employees must be given that same opportunity, with limited exceptions. A mistake in this area may lead to the entire 403(b) plan losing its tax-deferred status. In order to avoid disqualification, Plan Sponsors are required to provide written meaningful notice to all eligible employees at least once per year.

In July, 2010, the health reform bill created the Pre-Existing Condition Exclusion Plan (PCIP) to provide health insurance coverage to uninsurable citizens. Currently, 24 states (including District of Columbia) administer their own PCIP program. The federal government and HHS run the program on behalf of the remaining states.

Eligibility for PCIP is based on the following criteria:

Legal citizen of the United States

Uninsured for 6-months prior to application

Denied an individual health insurance plan due to a pre-existing condition

The next few years should prove to be a challenging time in healthcare - a veritable "perfect storm" of consolidation, IT implementation, payment changes and physician integration. At the 2010 Huron Healthcare CEO Forum, CEOs from top healthcare organizations discussed theirtop priorities for the next few years, as well as their tactics for dealing with upcoming challenges.

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